SafeGuardRx Improves Affordability and Access to Budget-Busting Drugs

Dec 15, 2015

Express Scripts SafeGuardRxSM represents the next wave of innovation that uniquely addresses the biggest challenges clients are facing.

Tags

Cancer

Hepatitis C

High Blood Cholesterol

Building on the bold actions Express Scripts has taken to deliver better patient care, greater access to medicine and lower costs for payers, we are launching Express Scripts SafeGuardRx℠, a collection of novel solutions that will transform the pharmacy benefit.

Without our actions, drug prices and trend would be set on an unsustainable trajectory for the employers and health plans that shoulder the burden of healthcare costs. For nearly 30 years, Express Scripts has stood alongside our clients, putting medicine within reach by inventing cost-saving solutions that provide great care to patients. Today, we are building upon our heritage by bringing together a unique suite of solutions to keep clients ahead of the cost curve. SafeGuardRx represents the next wave of innovation from Express Scripts that will enhance the value of the pharmacy benefit.

All current and future Express Scripts SafeGuardRx solutions target the medication classes that will pose the largest budgetary threats to payers.

In addition to two programs the company already introduced – the Hepatitis Cure Value Program℠ (HCV) and the Cholesterol Care Value Program℠ (CCV) – which both improved access to innovative drugs and provided a pathway to the best possible care through the Accredo specialty pharmacy, Express Scripts is announcing two new programs: the Oncology Care Value Program® (OCV) and the Inflation Protection Program.

Our programs for hepatitis C and high cholesterol were industry firsts, and both programs helped protect clients from millions in unnecessary spend. We are enhancing these solutions to deliver more financial value to enrolled clients. In addition, we’re introducing two unprecedented solutions that will uniquely address the biggest challenges clients are facing: high-cost cancer drugs and continued inflation of brand drugs.

Oncology Care Value Program®

Launching in 2016, the OCV Program will protect payers from unnecessary spending while ensuring patients are treated with the right drug for their condition at the right price.

While some oncology medications are indicated to treat multiple types of cancer, the cost of treatment may not align with its outcomes for various types of cancer. Additionally, some patients may not respond to therapy. As the country’s first program to factor these differences into value-based prescription drug payments, Express Scripts’ OCV Program will take a multi-faceted approach to align cost of treatment with its outcomes. The program will focus in 2016 on prostate cancer, lung cancer, and renal cell carcinoma. In subsequent years, Express Scripts plans to apply this approach when treating other cancer categories.

The OCV Program leverages the specialization of Express Scripts’ Oncology Therapeutic Resource Center (TRC) through exclusive dispensing of all oncology medications through the Accredo specialty pharmacy. Patients will begin therapy with clinically appropriate and cost-effective medication for a specific indication. The Oncology TRC team is extensively trained in sub-specialties for oncology therapies and provides patients with specialized support from more than 200 patient care advocates, 80 specialist pharmacists and 60 nurses.

Inflation Protection Program

According to the Express Scripts Prescription Price Index, the average price for the most commonly used brand-name drugs more than doubled (up 127%) in the United States between 2008 and 2014. Last year alone, nearly 20% of brand-name drugs experienced a price increase greater than 20%.

To address this portion of national drug spend that has continued to challenge payers, Express Scripts is launching another industry-first solution, our Inflation Protection Program. Beginning January 1, 2016, Express Scripts will shield participating plans from the full cost impact of year-over-year price increases on brand drugs.

All payers fear the unknown costs associated with future brand-drug price inflation. By being creative with our contracts with drug manufacturers, and by taking on our own financial risk, Express Scripts is delivering more value and budget predictability to the payers and patients we serve.

Cholesterol Care Value Program

When a new class of cholesterol lowering medications – known as PCSK9 inhibitors – was approved earlier this year, Express Scripts protected plans from unnecessary costs by launching the CCV Program. Effective January 1, 2016, enrolled clients will have a per-member-per-year cost cap on PCSK9 inhibitors. This cap will apply to PCSK9 inhibitor prescriptions that are obtained through Accredo in 2016 for patients enrolled in a plan participating in the CCV Program. All existing benefits of the CCV Program remain, including a rigorous clinical review process with required documentation and specialist pharmacist support through Accredo.

Hepatitis Cure Value Program

Launched late last year, the HCV Program successfully lowered the cost of curative treatments by nearly 50% in 2015 and created an unprecedented solution for improving patient care and maximizing cost savings. Effective January 1, 2016, each plan participating in the HCV Program will receive an additional discount of at least $2,000 for every patient receiving Viekira Pak™ through Accredo. All existing benefits of the program remain, including specialist pharmacist support through Accredo and medication adherence guarantees.